Famous Patients and Ophthalmoscopes

For Medical Mondays today, I have two questions. The first is probably easiest to answer by anyone, the second is maybe a little more specific.

1. What do you do when you have a famous patient?

I may or may not have treated a somewhat famous person in the past. Not Mandela-famous, but anyway. I believe in confidentially so I’m not asking about blogging or anything, but what I’m wondering is how you would approach such a consultation. Does one pretend that you have no idea who the person is, or do you refer to their work and ask how things are going?

2. How do you use an ophthalmoscope?

I am currently rotating through Ophthalmology, a discipline I have always been interested in, and I am thoroughly enjoying it. However, the handheld ophthalmoscope is proving a real challenge. I think I’m doing everything like I should, yet it is nearly impossible for me to make sense of what I see on fundoscopy. I am correcting for my myopia, I am dimming the room appropriately, I am using the dial to focus more. I generally manage to locate the disk, but I struggle to identify the border of the cup. IT LOOKS NOTHING LIKE IN THE TEXTBOOK PICTURES, GUYS! Ugh. Our doctors say it just becomes clearer with more practice, but I worry that there is something I’m missing. Any advice?

if you have any thoughts on these questions, I look forward to hearing them. Or, you can click below for another recent post. 🙂

I’ve been practicing for 8 years and I can still barely make out much of anything with the ophthalmoscope. Ha ha!! The few times I’ve seen the cup/disc, I have had no idea if it’s normal or not. Usually if I see the vessels, I call it a good day! 😉

In all seriousness, if I am that worried about someone’s eye, they are usually seen by an ophthalmologist within a few days (this is the luxury of working in the city).

The only “a-ha” moment I ever had when it came to an eye exam was when I picked up a RAPD in a young woman later diagnosed with MS.

As for a famous patient – I do have one in my practice. Famous in the sense that she is an actress on a television show which I do not watch but know of.

Oh, that’s funny! So glad I’m not alone. Some days it’s a real accomplishment to even see a vessel!
That’s a fair point. I guess I’m just worrying about the first few years post-graduation where I’ll be in a rural area without immediate ophthal assistance.
Very cool about the RAPD – the whole pupillary pathway still manages to confuse me most days.

haha these are great questions! I am only an MS2 so anything I see through an opthalmoscope doesn’t mean much to me. BUT I seem to be able to at least see the things I’m supposed to (however, I’m pretty much convinced that this is blind (haha) luck) 🙂

1. I once delivered the baby of a physician whom I worked under in my home hospital. She didn’t care. In general, I guess it depends on how “famous” they are. I would say, acknowledge them in some way, but don’t let it affect how you treat them as a patient.
2. I hate using ophthalmoscopes and I still don’t think I know how to use them properly. First off, I can only close my left eye, not my right, so I always get in trouble for not using the same eye as the patient. Second, I don’t know what I’m looking at half the time. I passed my osce station on pure luck. Good luck to you, though!

That’s so weird about delivering a physician’s baby – I was actually thinking how if I ever go into academia I might do that too. But then again, I might just traumatise the student completely. Haha. Or feel awkward.
Thanks for the advice, acknowledging is probably wise so they don’t think we’re complete idiots 😛
As for ophthalmoscopes, I’m getting better, slowly, but they are really difficult! Those big fancy ones the consultants use are so much better. I can’t close one eye at a time at all though, so right now I’m blocking one eye with one hand, which is a little awkward. But thanks! We will learn!